MRS. MARY DISSELKOEN (NPI# 1457596090) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457596090 |
| Entity Type | Individual |
| Full Name | MRS. MARY DISSELKOEN |
| Practice Address |
1353 Van Auken St Se Grand Rapids MI 49508-2516 |
| Practice Telephone | 6168192685 |
| Practice Fax Number | 6168192684 |
| Mailing Telephone | 6168192685 |
| Mailing Fax Number | 6168192684 |
| Enumeration Date | 2008-12-11 |
| Last Update Date | 2008-12-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 231H00000X | Audiologist | 1601000230 | MI | Speech, Language and Hearing Service Providers |
| N | 231HA2400X |
Audiologist Specialization: Assistive Technology Practitioner |
1601000230 | MI | Speech, Language and Hearing Service Providers |
| N | 237600000X | Audiologist-Hearing Aid Fitter | 1601000230 | MI | Speech, Language and Hearing Service Providers |
| Street Address |
1353 VAN AUKEN ST SE |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49508-2516 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063012367 | Jenna Brianne Labrecque | Social Worker | 2013 East Castle Dr, Suite B, Kentwood, MI 49508 | 2020-10-27 |
| 1881208809 | Morgan Paige Ballmann | Physical Therapy Assistant | 4150 Kalamazoo Ave. Se, Grand Rapids, MI 49508 | 2020-09-08 |
| 1699385740 | Jodie Lynn Robertson | Prosthetist | 3720 Eastern Se, Grand Rapids, MI 49508 | 2020-08-04 |
| 1003460874 | Derm Institute of West Michigan Plc | Dermatology | 6750 Kalamazoo Ave, Suites C & D, Grand Rapids, MI 49508 | 2019-07-30 |
| 1255801833 | Ikeia Tynika Hill | Licensed Practical Nurse | 1627 Lotus, Grand Rapids, MI 49508 | 2018-11-27 |
| 1326556838 | Araceli Contreras-hernandez | Behavior Technician | 3566 Eastern Ave. Se, Kentwood, MI 49508 | 2018-01-18 |
| 1881102788 | A Grand Rapids Senior Social Exchange and Adult Day Center | In Home Supportive Care | 3212 Eastern Ave Se, Grand Rapids, MI 49508 | 2018-01-14 |
| 1952827107 | Nupoint Services LLC | Clinic/Center | 1620 44th Street Se, Grand Rapids, MI 49508 | 2017-08-19 |
| 1710427695 | Embracing Life Afc | Custodial Care Facility | 1405 Forrester St S.e., Grand Rapids, MI 49508 | 2017-02-27 |
| 1083162838 | Katherine Berenice Campoverde Arevalo | Technician, Other | 1157 Billigs Ct Se, Ap# 1a, Grand Rapids, MI 49508 | 2016-09-21 |
| Find all providers in zip 49508 | ||||
| Taxonomy Code | 231H00000X |
| Grouping | Speech, Language and Hearing Service Providers |
| Classification | Audiologist |
| (1) A specialist in evaluation, habilitation and rehabilitation of those whose communication disorders center in whole or in part in hearing function. Audiologists are autonomous professionals who identify, assess, and manage disorders of the auditory, balance and other neural systems. Audiologists provide audiological (aural) rehabilitation to children and adults across the entire age span. Audiologists select, fit and dispense amplification systems such as hearing aids and related devices. (2) An audiologist is a person qualified by a master’s degree in audiology, licensed by the state, where applicable, and practicing within the scope of that license. Audiologists evaluate and treat patients with impaired hearing. They plan, direct and conduct rehabilitative programs with audiotry substitutional devises (hearing aids) and other therapy. |
| Notes: Source: (1) American Speech-Language-Hearing Association, (1996, Spring) Scope of practice in Audiology, p. 2 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073143210 | Megan Justine Gustavson | Audiologist | 6140 28th St Se Ste 205, Grand Rapids, MI 49546-6938 | 2020-01-15 |
| 1730439225 | William Allen Hodgson | Audiologist | 803 Ne 1st Ave, Grand Rapids, MN 55744-2751 | 2012-09-12 |
| 1750535373 | Jack De Boer | Audiologist | 2036 Chesaning Dr Se, Grand Rapids, MI 49506-5309 | 2008-11-10 |
| 1740452200 | Susan Jane Haveman-kruyf | Audiologist | 655 Kenmoor Ave Se Ste A, Grand Rapids, MI 49546-8622 | 2008-03-25 |
| 1023299088 | Sharon K. Hickox | Audiologist | 4055 Cascade Rd Se Ste 201, Grand Rapids, MI 49546-2149 | 2007-11-19 |
| 1932329729 | Theresa Marie Bosworth | Audiologist | 1425 Michigan Ne Suite A, Grand Rapids, MI 49503 | 2007-04-26 |
| 1164575833 | Edward Joseph Szumowski | Audiologist | 4232 29th St Se, Grand Rapids, MI 49512-1936 | 2007-01-18 |
| 1093878480 | Karen Ann Jacobs | Audiologist | 5344 Plainfield Ave Ne, Suite 4, Grand Rapids, MI 49525-1009 | 2006-12-18 |
| 1588697411 | Denise Ann Hove | Audiologist | 1542 Golf Course Rd Ste 204, Grand Rapids, MN 55744-3555 | 2006-07-07 |
| 1558848374 | Karson Glass | Audiologist | 6140 28th St Se, Grand Rapids, MI 49546-6938 | 2018-07-24 |
| Find all providers in GRAND RAPIDS | ||||
| City | GRAND RAPIDS |
| Zip Code | 49508 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.